Official Form 410 - Proof Of Claim (Page 4 of 5) in pdf

Official Form 410

Instructions for Proof of Claim

United States Bankruptcy Court

04/16

These instructions and definitions generally explain the law. In certain circumstances, such as bankruptcy cases that debtors do

not file voluntarily, exceptions to these general rules may apply. You should consider obtaining the advice of an attorney,

especially if you are unfamiliar with the bankruptcy process and privacy regulations.

A person who files a fraudulent claim could be fined up to

PLEASE SEND COMPLETED PROOF(S) OF CLAIM

$500,000, imprisoned for up to 5 years, or both.

TO:

18 U.S.C. §§ 152, 157 and 3571

rue21 Claims Processing Center

c/o KCC

2335 Alaska Avenue

El Segundo, CA 90245

How to fill out this form

Fill in all of the information about the claim as of the

date the case was filed.

A Proof of Claim form and any attached documents

must show only the last 4 digits of any social security

number, individual’s tax identification number, or

Fill in the caption at the top of the form

financial account number, and only the year of any

person’s date of birth. See Bankruptcy Rule 9037.

If the claim has been acquired from someone else,

then state the identity of the last party

who owned

For a minor child, fill in only the child’s initials and the

the claim or was the holder of the claim and who

full name and address of the child’s parent or guardian.

transferred it to you before the initial claim was filed.

For example, write A.B., a minor child (John Doe, parent, 123

Main St., City, State). See Bankruptcy Rule 9037.

Attach any supporting documents to this form.

Attach redacted copies of any documents that show that

Confirmation that the claim has been filed

the debt exists, a lien secures the debt, or both. (See

the definition of redaction on the next page.)

To receive confirmation that the claim has been filed, either

Also attach redacted copies of any documents that show

enclose a stamped self-addressed envelope and a copy of this

perfection of any security interest or any assignments or

form or you may view a list of filed claims in this case by

transfers of the debt. In addition to the documents, a

visiting the Claims and Noticing and Agent’s website at

summary may be added. Federal Rule of Bankruptcy

Procedure (called “Bankruptcy Rule”) 3001(c) and (d).

Understand the terms used in this form

Do not attach original documents because

Generally, an expense that arises

Administrative expense:

attachments may be destroyed after scanning.

after a bankruptcy case is filed in connection with operating,

liquidating, or distributing that bankruptcy estate.

11 U.S.C. § 503

If the claim is based on delivery health care goods

or services, do not disclose confidential health care

information. Leave out or redact confidential

A creditor’s right to receive payment for a debt that the

Claim:

information both in the claim and in the attached

debtor owed on the date the debtor filed for bankruptcy. 11

documents.

U.S.C. §101 (5). A claim may be secured or unsecured.

Official Form 410 - Proof Of Claim Page 4

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